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May 22, 2026Circulation

Adolescent Cardiorespiratory Fitness and the Trade-Off Between Atrial Fibrillation Risk and Cardiovascular Benefits: A Nationwide Sibling-Controlled Cohort Study

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Authors

MBMarcel BallinACAxel C. CarlssonPWPer Wändell

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Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

MBMarcel BallinResearcher, Uppsala University

“Our study shows that there are good reasons to nuance and tone down the message, which has been widespread at times, that high levels of fitness or participating in races would pose a big risk to a person's cardiovascular health. The risk of atrial fibrillation is certainly not zero, but that said, the benefits are significantly greater.”

Uppsala UniversityNews Coverage
MBMarcel BallinResearcher, Uppsala University

“We were then able to see that the age-dependent effect disappeared. Instead, we saw that the net effect was positive from the start, and that the benefits were greater as age increased. From a lifelong perspective, the findings show that the benefits of high levels of fitness outweigh the risks.”

Uppsala UniversityNews Coverage

Overview

Cohort study shows cardiorespiratory fitness impacts atrial fibrillation risk and cardiovascular benefits in young men, indicating safe fitness levels.

Key Points

  • To explore the relationship between adolescent cardiorespiratory fitness and the risk of atrial fibrillation versus cardiovascular benefits.
  • Cohort study with sibling control analysis of Swedish men (N=1,124,049) from military conscription exams (1972-1995)
  • Used flexible parametric regressions to estimate standardized cumulative risk differences by fitness deciles
  • Outcomes included atrial fibrillation and non-atrial fibrillation cardiovascular disease, with data from national registries until December 31, 2023.
  • 4.0% of participants experienced atrial fibrillation and 8.6% had non-atrial fibrillation cardiovascular disease
  • After age 35, reductions in non-atrial fibrillation cardiovascular disease were greater than the increase in atrial fibrillation risk, with an RD of -0.11% vs 0.06%
  • By age 65, non-atrial fibrillation cardiovascular disease reduction was larger (RD -3.91%) compared to atrial fibrillation excess (RD 2.30%).

Cite This Study

Ballin et al. (2026) studied this question.

synapsesocial.com/papers/6a10c85127ccddac213a3e0bhttps://doi.org/10.1161/circulationaha.125.078250
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiorespiratory fitness in adolescence and risk of type 2 diabetes in late adulthood in one million Swedish men: nationwide sibling controlled cohort study2025
  2. 2Association of Self-reported Sports Volume and Discipline with Atrial Arrhythmia Prevalence in Middle-Aged Males2026 · 1 citations
  3. 3CARDIORESPIRATORY FITNESS AND ITS ROLE IN MANAGING ATRIAL FIBRILLATION: A LITERATURE REVIEW2025
  4. 4Cardiorespiratory Fitness and Population Attributable Risk: The ETHOS Study2026
  5. 5The timing and relationship of atrial fibrillation with exercise in veteran male endurance athletes2026